Healthcare Provider Details

I. General information

NPI: 1013826155
Provider Name (Legal Business Name): CHILDREN'S HOME AND AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 JOHNSON RD
GRANITE CITY IL
62040-3984
US

IV. Provider business mailing address

200 W MONROE ST STE 2100
CHICAGO IL
60606-5071
US

V. Phone/Fax

Practice location:
  • Phone: 618-452-8900
  • Fax:
Mailing address:
  • Phone: 312-424-0200
  • Fax: 312-242-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MIKE SHAVER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 312-424-6801